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Ahmed N, Herbert S, Arenas-Pinto A, Rickman H, Benn P, Edwards SG, Chiodini PL, Grant AD. Trypanosoma cruzi screening in people living with HIV in the UK. Int J STD AIDS 2024; 35:71-73. [PMID: 37728103 DOI: 10.1177/09564624231202292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
People living with HIV (PLWH) are at higher risk of reactivation of Chagas disease, a neglected tropical disease, caused by Trypanosoma cruzi. There are no data from UK HIV clinics on the prevalence of T. cruzi. We implemented T. cruzi screening at our clinic as part of routine care for PLWH with epidemiological risk factors. Among 86 patients screened, none had positive serology: one seropositive patient was identified due to increased clinician awareness. Implementing T. cruzi screening as part of routine clinical care was feasible, though labour intensive and identified at-risk individuals.
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Affiliation(s)
- Nadia Ahmed
- Genito-Urinary Medicine, Central North West London NHS Trust, UK
| | - Sophie Herbert
- Genito-Urinary Medicine, Central North West London NHS Trust, UK
| | - Alejandro Arenas-Pinto
- Genito-Urinary Medicine, Central North West London NHS Trust, UK
- Centre for Sexual Health & HIV Research, University College London, UK
| | - Hannah Rickman
- Genito-Urinary Medicine, Central North West London NHS Trust, UK
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
| | - Paul Benn
- Genito-Urinary Medicine, Central North West London NHS Trust, UK
| | - Simon G Edwards
- Genito-Urinary Medicine, Central North West London NHS Trust, UK
| | - Peter L Chiodini
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
- Parasitology, Hospital for Tropical Diseases, UK
| | - Alison D Grant
- Genito-Urinary Medicine, Central North West London NHS Trust, UK
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
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Gonzalez-Sanz M, Crespillo-Andújar C, Chamorro-Tojeiro S, Monge-Maillo B, Perez-Molina JA, Norman FF. Chagas Disease in Europe. Trop Med Infect Dis 2023; 8:513. [PMID: 38133445 PMCID: PMC10747626 DOI: 10.3390/tropicalmed8120513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Chagas disease is currently present in many non-endemic countries and remains a neglected tropical disease globally. A review of the literature identified significant gaps and scarcity of updated information from European countries, with most studies reporting data from Spain and Italy. The index of underdiagnosis may be as high as 70%, affecting mainly females of child-bearing age. Standardized screening of fertile, non-pregnant, women from endemic countries and subsequent treatment is considered an essential strategy to control transmission and prevent new cases, yet no uniform legislation for screening risk groups exists. There is heterogeneity in Europe in terms of preventive strategies to avoid transfusion-related transmission of Chagas disease, not necessarily in line with the European directives, with some countries conducting systematic screening for T. cruzi infection in blood donors, whilst others rely on pre-transfusion questionnaires. The growing burden of the infection in resource-rich areas may provide an opportunity for progress in certain aspects of control and prevention. Options for improving screening strategies, management and linkage to care are reviewed.
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Affiliation(s)
- Marta Gonzalez-Sanz
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
| | - Clara Crespillo-Andújar
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Sandra Chamorro-Tojeiro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Universidad de Alcalá, 28801 Alcalá de Henares, Spain
| | - Begoña Monge-Maillo
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Universidad de Alcalá, 28801 Alcalá de Henares, Spain
| | - Jose A. Perez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francesca F. Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Universidad de Alcalá, 28801 Alcalá de Henares, Spain
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3
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Herrero-Martínez JM, Trigo E, Navarro M, García-Alcázar D, Carrillo I, Fernández-López T, Calderón-Moreno M, Millán-Pérez R, Cuadros J, Velasco M, García-Bujalance S, Lizasoain M, Martín-Rabadán P, Pérez-Ayala A, Flores-Chávez M. Prevalence of Chagas disease in Latin American pregnant women in Madrid, Spain: A multicentre cross-sectional study from 2011 to 2016. Trop Med Int Health 2023; 28:912-922. [PMID: 37905331 DOI: 10.1111/tmi.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The aim of this study is to assess Trypanosoma cruzi infection prevalence among pregnant migrants living in Madrid according to the country of origin and to assess screening coverage in this at-risk population. METHODS Retrospective multicentre cross-sectional study conducted from January 2011 to December 2016 in eight Madrid hospitals. Each hospital reviewed their microbiology data records to assess the screening coverage and serological diagnosis in all pregnant women coming from endemic areas. RESULTS From 2011 to 2016, 149,470 deliveries were attended at the eight hospitals, and 11,048 pregnant women were screened for Chagas disease. Most cases (93.5%) were in women from Bolivia, who also showed the highest prevalence (12.4%, 95% confidence interval: 9.9-15.0). Pooled prevalence amongst the screened women was 2.9% (95% CI: 1.8-4.1). Chagas disease screening coverage varied greatly between centres, with a pooled mean coverage of 47% (95% CI: 37%-57%; 73% [95% CI: 63%-82%] for those centres with universal screening vs. 10% [95% CI: 6%-15%] for those with a selective screening approach; p < 0.001). CONCLUSION Our study provides useful data for policy makers and epidemiologists in a non-endemic area without congenital Chagas screening programmes.
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Affiliation(s)
| | - Elena Trigo
- Travel and Tropical Medicine Referral Unit. La Paz-Carlos III University Hospital, Madrid, Spain
| | - Miriam Navarro
- Epidemiology Unit, Public Health Centre of Elche-FISABIO, Alicante, Spain
- Department of Public Health, Science History and Gynaecology, University Miguel Hernández de Elche, Alicante, Spain
| | - Diana García-Alcázar
- Obstetrics and Gynaecology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - Irene Carrillo
- Infectious Diseases Division, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | - María Calderón-Moreno
- Internal Medicine Department, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Rosario Millán-Pérez
- Microbiology Department, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Juan Cuadros
- Microbiology Department, Hospital Príncipe de Asturias, Madrid, Spain
| | - María Velasco
- Internal Medicine Department, University Hospital Fundación de Alcorcón, Madrid, Spain
| | | | - Manuel Lizasoain
- Infectious Diseases Unit, Internal Medicine Department, University Hospital 12 de Octubre, Madrid, Spain
| | - Pablo Martín-Rabadán
- Microbiology Department, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Ana Pérez-Ayala
- Microbiology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - María Flores-Chávez
- Reference and Research Laboratory in Parasitology, National Centre of Microbiology, Madrid, Spain
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Ramírez-Olivencia G, Arsuaga M, Torrús D, Belhassen-Garcia M, Rodríguez-Guardado A, Herrero-Mendoza M, Mateo-Maestre M, Campos-Rivas R, Membrillo-de Novales F. Prevalencia de alteraciones digestivas asociadas a Chagas importado (estudio PADChI): un estudio observacional. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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Suárez C, Nolder D, García-Mingo A, Moore DAJ, Chiodini PL. Diagnosis and Clinical Management of Chagas Disease: An Increasing Challenge in Non-Endemic Areas. Res Rep Trop Med 2022; 13:25-40. [PMID: 35912165 PMCID: PMC9326036 DOI: 10.2147/rrtm.s278135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
Chagas disease (CD) is caused by the parasite Trypanosoma cruzi, and it is endemic in Central, South America, Mexico and the South of the United States. It is an important cause of early mortality and morbidity, and it is associated with poverty and stigma. A third of the cases evolve into chronic cardiomyopathy and gastrointestinal disease. The infection is transmitted vertically and by blood/organ donation and can reactivate with immunosuppression. Case identification requires awareness and screening programmes targeting the population at risk (women in reproductive age, donors, immunocompromised patients). Treatment with benznidazole or nifurtimox is most effective in the acute phase and prevents progression to chronic phase when given to children. Treating women antenatally reduces but does not eliminate vertical transmission. Treatment is poorly tolerated, contraindicated during pregnancy, and has little effect modifying the disease in the chronic phase. Screening is easily performed with serology. Migration has brought the disease outside of the endemic countries, where the transmission continues vertically and via blood and tissue/organ donations. There are more than 32 million migrants from Latin America living in non-endemic countries. However, the infection is massively underdiagnosed in this setting due to the lack of awareness by patients, health authorities and professionals. Blood and tissue donation screening policies have significantly reduced transmission in endemic countries but are not universally established in the non-endemic setting. Antenatal screening is not commonly done. Other challenges include difficulties accessing and retaining patients in the healthcare system and lack of specific funding for the interventions. Any strategy must be accompanied by education and awareness campaigns directed to patients, professionals and policy makers. The involvement of patients and their communities is central and key for success and must be sought early and actively. This review proposes strategies to address challenges faced by non-endemic countries.
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Affiliation(s)
- Cristina Suárez
- UK Chagas Hub, London, UK.,Department of Infection, Barts Health NHS Trust, London, UK
| | - Debbie Nolder
- UK Chagas Hub, London, UK.,Diagnostic Parasitology Laboratory, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana García-Mingo
- UK Chagas Hub, London, UK.,Microbiology Department, Whittington Health NHS Trust, London, UK
| | - David A J Moore
- UK Chagas Hub, London, UK.,Hospital for Tropical Diseases, University College London Hospitals NHS Trust;, London, UK.,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter L Chiodini
- UK Chagas Hub, London, UK.,Hospital for Tropical Diseases, University College London Hospitals NHS Trust;, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
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Worldwide Control and Management of Chagas Disease in a New Era of Globalization: a Close Look at Congenital Trypanosoma cruzi Infection. Clin Microbiol Rev 2022; 35:e0015221. [PMID: 35239422 PMCID: PMC9020358 DOI: 10.1128/cmr.00152-21] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Population movements have turned Chagas disease (CD) into a global public health problem. Despite the successful implementation of subregional initiatives to control vectorial and transfusional Trypanosoma cruzi transmission in Latin American settings where the disease is endemic, congenital CD (cCD) remains a significant challenge. In countries where the disease is not endemic, vertical transmission plays a key role in CD expansion and is the main focus of its control. Although several health organizations provide general protocols for cCD control, its management in each geopolitical region depends on local authorities, which has resulted in a multitude of approaches. The aims of this review are to (i) describe the current global situation in CD management, with emphasis on congenital infection, and (ii) summarize the spectrum of available strategies, both official and unofficial, for cCD prevention and control in countries of endemicity and nonendemicity. From an economic point of view, the early detection and treatment of cCD are cost-effective. However, in countries where the disease is not endemic, national health policies for cCD control are nonexistent, and official regional protocols are scarce and restricted to Europe. Countries of endemicity have more protocols in place, but the implementation of diagnostic methods is hampered by economic constraints. Moreover, most protocols in both countries where the disease is endemic and those where it is not endemic have yet to incorporate recently developed technologies. The wide methodological diversity in cCD diagnostic algorithms reflects the lack of a consensus. This review may represent a first step toward the development of a common strategy, which will require the collaboration of health organizations, governments, and experts in the field.
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Cinardo P, Farrant O, Gunn K, Ward A, Eisen S, Longley N. Screening for neglected tropical diseases and other infections in refugee and asylum-seeker populations in the United Kingdom. Ther Adv Infect Dis 2022; 9:20499361221116680. [PMID: 35958977 PMCID: PMC9358592 DOI: 10.1177/20499361221116680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Asylum-seekers and refugees have an increased burden of infections compared with the general population. This has been widely recognised by countries welcoming those fleeing conflict and persecution; however, there are no screening standardised guidelines and regulatory processes. Identification of certain neglected tropical diseases (NTDs) and other infections is important for the health and well-being of the individual in addition to public health and biosecurity. In the United Kingdom, screening for infections at port of entry or after arrival is not mandatory. Those on refugee resettlement programmes will have infection screening as part of their pre-entry health assessment, but no such system exists for those claiming asylum in the United Kingdom. In this article, we have reviewed published, peer-reviewed articles looking at the approaches to screening for NTDs and infectious diseases in the United Kingdom. In addition to this, we have reviewed the literature looking at the acceptability, barriers and facilitators of these screening practices. We found that there is a heterogeneous approach to screening practices in the United Kingdom and a paucity of data to support a single ‘best practice’ approach. Based on our findings, we have made recommendations and consideration for NTD screening strategies and highlighted important areas for future research.
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Affiliation(s)
- Paola Cinardo
- Clinical Research Fellow, Acute Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, London, UK
| | - Olivia Farrant
- Infectious Diseases, Hospital for Tropical Diseases, London, UK; Acute Medicine, University College Hospital, London, UK
| | - Kimberlee Gunn
- Division of Infection and Immunity, University College Hospital, London, UK
| | - Allison Ward
- Children's & Adolescent Services, Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Eisen
- Children and Young People's Services, University College Hospital, London, UK
| | - Nicky Longley
- Infectious Diseases and Travel Medicine, Hospital for Tropical Diseases, London, UK
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Dantas RO. Management of Esophageal Dysphagia in Chagas Disease. Dysphagia 2021; 36:517-522. [PMID: 33855597 DOI: 10.1007/s00455-021-10297-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
Chagas disease, caused by the infection of the protozoan parasite Trypanosoma cruzi, has clinical consequences in the heart and digestive tract. The most important changes in the digestive tract occur in the esophagus (megaesophagus) and colon (megacolon). Esophageal dysfunction in Chagas disease results from damage of the esophageal myenteric plexus, with loss of esophageal peristalsis, partial or absent lower esophageal sphincter relaxation, and megaesophagus, which characterizes secondary esophageal achalasia. The treatment options for the disease are similar to those for idiopathic achalasia, consisting of diet and behavior changes, drugs, botulinum toxin, peroral endoscopic myotomy (POEM), pneumatic dilation of the lower esophageal sphincter, laparoscopic Heller myotomy, and esophagectomy. Chagas disease causes a life-threatening cardiopathy, and this should be considered when choosing the most appropriate treatment for the disease. While some options are palliative, for temporary relief of dysphagia (such as drugs, botulinum toxin, and pneumatic dilation), other therapies provide a long-term benefit. In this case, POEM stands out as a modern and successful strategy, with good results in more than 90% of the patients. Esophagectomy is the option in Chagas disease patients with advanced megaesophagus, despite the increased risk of complications. In these cases, peroral endoscopic myotomy may be an option, which needs further evaluation.
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Affiliation(s)
- Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Campus da USP, Ribeirão Preto, SP, Brazil.
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